Healthcare Transformation and Fire Service EMS Mark Stevens BA, EMTP

1. Healthcare Transformation and Fire Service EMS Mark Stevens BA, EMTP

4. Primary Care Specialty Care Ambulatory Care Emergency Dept Urgent Care Nursing Home Home Health Pharmacy

5. Reporting Hospitals - 2007 Physicians - 2009 “Failure to submit data for FY 2007 and beyond results in a 2% decrease in Medicare reimbursement.”… (Additional impact after Oct 1, 2012.) 17 Clinical care measures in 5 categories: (AMI, Heart failure, Pneumonia, HC assoc infection, Surg improve) 8 Consumer assessments: (doc/nurse communication, staff responsiveness Pain mgmt, Cleanliness/quietness of environ.)

6. Physicians: 3 Financial incentive plans • Quality reporting (199) • Electronic Prescribing • Electronic Health Records

7. EMS/Ambulance • Quality Measures • Accreditation/Certification • Electronic Records • Consumer Satisfaction • Efficiencies

8. Hospitals Pharmacy Labs Consumers Healthcare Information Exchange Physicians Clinics Govt Medicaid/Pub H EMS Payers

9. Health Information Exchange The first call of the day was a 43 yo male that was found laying in the front yard of a residence. I was able to find the pt’s medical hx of seizure, and his last ER visit to OUMC. SMRTNET was used to confirm pt’s information she provided to me. Pt stated she had no allergies, however SMRTNET found allergies in hx. Upon questioning pt remembered “yes” to allergic to… EMSA, Oklahoma City

10. 80% of HC $’s spent on 20% of people Known causes and preventable. Current direction will bankrupt State/Country

11. Oregon’s “Triple Aim” (HB3650) • Improve lifelong health of all Oregonians. • Increase quality, reliability and availability • of care for all Oregonians. • Lower or contain the cost of care so it is • affordable for everyone.

12. Oregon Health Policy Board HB3650 CMS Integration Work grp CCO Work grp Global Budget Work grp Metrics Outcome Quality

13. http://www.emmisolutions.com/medicalhome/pcpcc/english.html

15. Future Current Concepts Public Safety Public Health Community Health E S M

16. Bundling Healthcare Information Exchange Performance Dependent Reimbursement The “New Normal” Alternate funding No Money EMS Agenda for the Future Integration of EPCR Hospital records Never Events Accountable Care Organization Coordinated Care Organization Alternate Destination http://www.youtube.com/watch?v=Z1SBgCL1qTg

18. Be at the table Be on the table

20. Non-Traditional Health Workers Team: Community Health Workers Peer Wellness Specialists Personal Health Navigators Training: Core Competencies Cross-cultural communication/liaison Group/family dynamics, Advocacy skills, Knowledge of resources, Needs assessment *Opportunity

21. “Community Paramedic” UK – Dispatch, NonTraditional & MD Toronto – CREMS U.S. – Minnesota, Eagle CO, MedStar, Wake Co, Nebraska… Tucson, TVF&R, King Co Scope of Practice Training Programs

22. Things to watch for Medical Liability (next legislative session) CMS Innovation Challenge Grant Local CCO activity/relationships Non-Traditional Training opportunities Nursing Associations Protocols & Scope of Practice

23. Things to watch (know your numbers) Call breakdown: - Dry runs (# should drop) - No Pays (# should drop) - Freq caller (# should drop) - Number of transports to ED Evaluate: - Effect on operations/staffing - Transport revenue - Alternate destinations - Innovative ways to get right resource/right pt - Alternate revenue streams

24. What should we be doing? • Be aware of state/local changes • Support medical liability changes for EMS • Build relationships (CCOs, Medical Homes, hospital) • Market the value of EMS • Assess degree of involvement for your agency • Performance-based culture • Electronic charting (Image Trends)

25. Value of EMS • We are healthcare providers. • Infrastructure for quick response to • anywhere in our community. • EMS can assess/direct to alternate destination. • We can “fill the gaps” and support CCOs. • Clinics in fire stations? • Preventative health fairs? • Work under medical authority, QI. • Lessen hospital readmissions • Participate in care plans

27. What should we be doing? • - Think Innovation..right resource/pt/time • - Accountability: Not just about response time • Work smarter (deployment, resource/demand) • Develop people for expanded roles • Become integrated with healthcare systems • Position external stakeholders to be advocates

28. Diversify Revenues/Efficiencies Training Services Communication Services Occ Health Billing Vehicle maintenance Consolidate medical direction Share cost savings with payors

29. CMS Innovation Challenge Grant • First grant for EMS eligibility • $1 – 30 million/grant • Three years to be self-sustaining • Portland metro area (4 counties) • Dispatch triage (EMD & Nurse) • Alternate destination for 9-1-1 response • Post hospital discharge followup

30. Shifting emphasis of medical care from crisis intervention to prevention.

31. Don’t forget our mission… Reduce lives lost Reduce pain & suffering

32. http://health.oregon.gov

33. Your EMS Section Testimony Relationships/network EHC Governance Resources Links Legislation www.ofcaems.org

34. God, grant me the serenity to accept the things I cannot change, Courage to change the things I can, And wisdom to know the difference. Serenity Prayer

35. Resources www.health.oregon.gov www.ofcaems.org www.hitsp.org http://communityparamedic.org www.wecadems.com/cp.html www.medstar911.org/community-health-program www.wakegov.com/ems/staff/app.htm http://www.emmisolutions.com/medicalhome/pcpcc/english.html